UT Benefits for Employees: Plan Year 2013-2014

UT SELECT Medical Plan

AE Highlights

  • Slight coverage increase (see below)
  • No changes to copayments, deductibles, or out-of-pocket maximums
  • UTSW Network option will continue to provide greatly reduced or no out-of-pocket cost for UT SELECT members who receive services from a UTSW physician at a UTSW facility

New monthly Out-of-Pocket Cost for FULL TIME Employees

  • Employee Only: $0 (No change)
  • Employee& Spouse: $214.22 ($6.24 increase)
  • Employee & Child(ren): $224.05 ($6.53 increase)
  • Employee & Family: $421.86 ($12.29 increase)
  • Tobacco Premium Program: $0 to $90 per month based upon tobacco user status

New monthly Out-of-Pocket Cost for PART TIME Employees

  • Employee Only: $248.77 ($7.24 increase)
  • Employee& Spouse: $593.40 ($17.28 increase)
  • Employee & Child(ren): $556.26 ($16.20 increase)
  • Employee & Family: $885.26 ($25.78 increase)
  • Tobacco Premium Program: $0 to $90 per month based upon tobacco user status

UT offers UT SELECT, a self-funded medical PPO plan, administered by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

Choice of Doctors Each Time You Need Health Care

When you enroll in UT SELECT, you can receive care from any licensed doctor you choose; no referrals are required.  If you use a network doctor, you will receive the highest level of benefits, pay less out-of-pocket, and will usually not have to file any claims. If you use an out-of-network doctor, you will still be covered, but your out-of-pocket costs for health care services will be substantially higher. 

NETWORK - Network benefits are available to UT SELECT participants living in Texas, New Mexico and Washington, D.C. who receive services from providers who have a network contract agreement with BCBSTX. Network benefits may also be available when services are rendered by providers outside of Texas if that provider has a network contract agreement with the Blue Cross and Blue Shield plan in the state where services were rendered. Network providers have agreed to charge only up to the BCBSTX allowed amount. You are responsible for applicable deductibles, copays and/or coinsurance.

UTSW Network- As an additional network option, the UTSW Network is a collaborative pilot program between The University of Texas Southwestern Medical Center and UT System OEB.  If any In-Area UT SELECT member receives medical care from a UTSW physician or at a UTSW facility, the out-of-pocket cost will be greatly reduced or eliminated.  Benefits include $10 primary care and $10 specialist copayment, no out-of-pocket cost for inpatient or outpatient care, no deductible, and no coinsurance.

Physician fees for services performed at affiliated hospitals are included in this benefit. However, the benefit does not include facility charges for other hospitals (e.g. Children’s Medical Center, VA North Texas Health Care System, Parkland Health & Hospital System, Baylor, and Texas Health Resources) even when a UTSW physician refers you to a non-UTSW facility. For Dallas and surrounding counties, UTSW has a clinically affiliated physician program (UTSCAP) in which UTSW selectively partners with quality internal medicine and family practice community physicians who are included in the UTSW Network. More information is available at http://www.bcbstx.com/ut/important.html or by contacting BCBSTX Customer Service.

OUT-OF-NETWORK – Out-of-network benefits are available to UT SELECT participants living in Texas, New Mexico and Washington, D.C. who receive services from providers who do not have a network contract agreement with BCBSTX. When receiving services from out-of-network providers, you will be responsible for applicable deductibles, copays and/or coinsurance, as well as any amounts exceeding the BCBSTX allowed amount.

OUT-OF-AREA - Out–of-Area benefits apply only to those UT SELECT participants whose residence of record is outside of Texas, New Mexico and Washington, D.C.

Preventive Care

Preventive care services are offered at no out-of-pocket cost. Eligible services are outlined in the federal regulations based on U.S. Preventive Service Task Force Recommendations.

To view a list of preventive care benefits offered through the UT SELECT Medical plan as well as information on preventive care benefits as required by the Affordable Care Act (healthcare reform), go to www.healthcare.gov. Please be aware that you may incur some cost if the preventive service is not the primary purpose of the visit or if your doctor bills for services that are not preventive.

UT SELECT and Medicare

Active Employees

In most cases, an active employee or dependent of an active employee enrolled in UT SELECT should enroll in Medicare Part A and decline Parts B and D once eligible, typically at age 65. Once you retire, you and your Medicare-eligible dependent(s) should then enroll in Part B without penalty and continue to waive Part D. In most instances, if you are eligible for Medicare and are working at UT in a benefits-eligible position for at least 20 hours per week, your UT medical plan will be primary for you and your covered dependent, regardless of age, and Medicare will be secondary. Medicare may be primary for some Medicare-eligible active employees with certain medical conditions such as end stage renal disease (ESRD). Consult with your local Social Security Administration office to learn what illnesses qualify for Medicare coverage prior to turning age 65.

Your Health Care Benefits Travel with You

Your UT SELECT Medical ID card features the Blue Cross and Blue Shield symbols and the PPO in a suitcase logo telling providers that you are part of the BlueCard program. This means you and your covered dependents have access to Blue Cross and Blue Shield network providers throughout the United States and around the world. To receive the network (highest) level of benefits when you need to seek care, please call 1-800-810-BLUE (2583) printed on your Medical ID card.

Transitional Benefits

If you or a covered dependent are being treated for certain chronic or ongoing medical conditions at the time you enroll in UT SELECT, and your doctor is not in the UT SELECT PPO network, ongoing care with your current doctor for up to three months may be requested.

Transitional benefits are subject to approval. To request transitional benefits, complete a “Transitional Benefits Form”available from your institution Benefits Office or online at www.bcbstx.com/ut.

 

 

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